Provider Demographics
NPI:1811985419
Name:BLOOD, RICHARD E II (LCPC)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:E
Last Name:BLOOD
Suffix:II
Gender:M
Credentials:LCPC
Other - Prefix:
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Mailing Address - Street 1:1755 WESTGATE DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-7174
Mailing Address - Country:US
Mailing Address - Phone:208-373-0790
Mailing Address - Fax:208-373-0816
Practice Address - Street 1:2717 W BANNOCK ST STE 101
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-4724
Practice Address - Country:US
Practice Address - Phone:208-314-1008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-09
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3288101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDQ5753OtherBLUE CROSS
ID000010147743OtherREGENCE BLUE SHIELD